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NPI Code Detail

MEDICARE: LAKE CITY REGIONAL MEDICAL GROUP LLC

MEDICARE: LAKE CITY REGIONAL MEDICAL GROUP LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician

General Provider Information

NPI Number : 1184910036
Entity Type Code : Organization
Provider Name (Legal Business Name) : LAKE CITY REGIONAL MEDICAL GROUP LLC
Provider Business Mailing Address
First Line : 2000 HEALTH PARK DR
Second Line :
City : BRENTWOOD
State : TN
Zip : 37027-4692
Country : US
Telephone Number : 615-373-7406
Fax Number : 866-831-4898
Provider Business Practice Location Address
First Line : 4225 NW AMERICAN LN
Second Line :
City : LAKE CITY
State : FL
Zip : 32055-8841
Country : US
Telephone Number : 386-758-6141
Fax Number : 386-758-6140
Authorized Official
Title or Position : VICE PRESIDENT
Name : JOHN MARK RODKEY
Credential :
Telephone Number : 850-523-3816
Provider Enumeration Date : 06/20/2011
Last Update Date : 10/21/2025

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Directions to “LAKE CITY REGIONAL MEDICAL GROUP LLC ” Practice Location

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